Report #2851632

Received Jul 29, 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: 76 yrs
State: IA
Recovered: Not recovered
Vaccinated: Jan 9, 2025
Onset: Jul 29, 2025
Days to onset: 201
Hospital days: —

Vaccines (1)

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

Symptoms (1)

Death

Symptom narrative

Resident expired

Medical history

UNSPECIFIED SYSTOLIC (CONGESTIVE) HEART FAILURE, ACUTE KIDNEY FAILURE, UNSPECIFIED, ATRIOVENTRICULAR BLOCK, FIRST DEGREE, VASCULAR DEMENTIA, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, HEMIPLEGIA, UNSPECIFIED AFFECTING UNSPECIFIED SIDE, UNSPECIFIED CONVULSIONS, ESSENTIAL (PRIMARY) HYPERTENSION, MIXED HYPERLIPIDEMIA, CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED, CHRONIC KIDNEY DISEASE, STAGE 2 (MILD), MAJOR DEPRESSIVE DISORDER, RECURRENT, MODERATE

Other medications

Amlodipine, atorvastatin, Furosemide, Lisinopril, Memantine, Methotrexate, Multivitamin, Omega-3, Sertraline, Terazosin, Vit. D3, Divalproex, Metoprolol Tartrate, Quetiapine, Senna,

Allergies

NKA