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Report #2849916

Received Jul 16, 2025

DiedHospitalizedER / ED visit
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
88 yrs
State
MN
Recovered
Not recovered
Vaccinated
Mar 16, 2021
Onset
Jul 7, 2025
Days to onset
1574
Hospital days
1

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA2026A21AIM

Symptoms (3)

COVID-19DeathSARS-CoV-2 RNA increased

Symptom narrative

HOSPITALIZATION AND DEATH RELATED TO COVID-19 FOLLOWING COMPLETION OF PRIMARY COVID VACCINE SERIES

Current illness

NONE KNOWN

Medical history

HYPERTENSION, PERIPHERAL VASCULAR DISEASE, SINGLE KIDNEY, CHRONIC KIDNEY DISEASE STAGE 4, HYPERCALCEMIA, IRON DEFICIENCY ANEMIA, HISTORY OF ABDOMINAL AORTIC ANYEURISM REPAIR

Other medications

CARVEDILOL 12.5MG TWICE DAILY; CYCLOBENZABRINE HCL 10MG AT BEDTIME AS NEEDED; OMEPRAZOLE 20MG TWICE DAILY; SIMVASTATIN 40MG DAILY; TYLENOL AS NEEDED; VERAPAMIL HCL ER 180MG TWICE DAILY; VITAMIN D-3 5000 IU DAILY

Allergies

CODEINE, DARVON, DEMEROL, MORPHINE, TRAMADOL, VALIUM

Lab data

7/7/25 SARS-COV-2 RNA DETECTED - NASAL SWAB